Hebrew School Registration

Family Information:

Hamptons Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Emergency Name*

First Name Last Name
Emergency Contact Phone Number*

Area Code Phone Number
Emergency Contact relation to student(s)*
Mother's Information:
Full Name*

First Name Last Name
Cell Phone Number*

Area Code Phone Number
E-mail*
Is mother Jewish by:

Choice Birth
Father's Information:
Full Name*

First Name Last Name
Cell Phone Number*

Area Code Phone Number
E-mail*
Be a part of it! Does either parent have a skill or resource they would like to volunteer/offer to Southampton Hebrew School of the Arts?
Child #1 Information:
Full Name*

First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
School your child attends*
Grade entering
Previous Jewish Education*
Does your child have any allergies or other medical condition we should be aware of?*

Yes No
If yes, please describe them and indicate special precautions or care needed
Child #2 Information:
Full Name

First Name Last Name
Hebrew Name
Birth Date

Month Day Year
School your child attends
Grade entering
Previous Jewish Education
Does your child have any allergies or other medical condition we should be aware of?

Yes No
If yes, please describe them and indicate special precautions or care needed
Medical Release Form
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of

Chabad of Southampton Hebrew School of the Arts to treat, hospitalize or secure treatment for

my child; I further agree to pay all charges for that care and/or treatment. It is understood that if

time and circumstances reasonably permit, Southampton Hebrew School of the Arts staff will

try, but are not required, to communicate with me prior to such treatment.
Electronic signature*
Signature Date

Month Day Year
Permissions:
I/we understand that my/our child(ren) may be included in photographs and video footage that

may be photographed or filmed during Southampton Hebrew School of the Arts . I authorize

Southampton Hebrew School of the Arts and Chabad of Southampton to use these

photos/videos to promote its programs and services in print, web, and other promotional

contexts.
*

I Agree
Payment:
Tuition is $2,000 per child and includes school tuition for the 2022-2023 school year, book fees, supplies and snacks.

Tuition is non-refundable.
Credit Card:

We accept Visa and Mastercard on this site

To submit payment using Amex please call the synagogue office: (631) 287-2249
Tuition Payment*

$2000 $4000

Payment*

Credit Card Check

Postal / Zip Code

Country

Total

$0.00
We believe that all Jewish children should have access to the best Jewish education. Funds shouldn't get in the way, period. If you feel you are in need of a scholarship, please reach out.
Should be Empty:

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Updates

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Upcoming Events

There are no events posted at this time. Please contact us for more info about our events.

For more info click here to contact us or call 631-287-2249

Educate Your Child... Educate a Generation

Family Information:

Mother's Information:

Father's Information:

Child #1 Information:

Child #2 Information:

Medical Release Form

Permissions:

Payment: